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FOR OFFICE USE: ------------------- ----------------------------------= ------------ ------- ----------- --- --- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. -- - (Complete in Duplicate) Date Issued _--/�-�/,��y _________________________________________________________ i i This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application'is made in compliance with County Ordinance No. 549. F-'SCA L.0 lq C,14 JOB ADDRESS AND LOC N.- I . d � 1.Lc1 1 � !c o rc' �/ Owner's Name------------- .------ 7f 00 9--y-------0,9-A=----l--C'`x- �;.- ----------------- . --------- Phone-----------------------•-----•----- Address---------------------------17--t------ ..� = 1� ftp f A Contractors Name---------0.'S7___1(1bl ' _ .k-------0,0 ^' '�' ----f j -9 �'�'�•-------- Phone-_-1f Installation will serve: Residencew[2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: ------ Numbed f bedrooms -2—__ Number of baths _f____ Lot size ----- - �4 ________________._______._ i Water Supply: Public system ❑ Community system ❑ Private IRO'Depth to Water Table _0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam R!r Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date----------__--------) No 6!re' New Construction: Yes O NJo ❑ FHA/VA: Yes ❑ No 2T'�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic-tank or-cesspool-permitted if public sewer is available witfiin-200 feet.} Septic Tank: Distance from nearest well-A-------------Distance from foundation--------------------Material_...___-______________.__________.._-----_--_. -� M Cr'No. of compartments------- ---V----Size----------------------------.___Liquid depth----------- -----------Capacity _Dis osal Field: Distance from nearest well-_._.O....._Distance from foundation---/4-----------Distance to nearest lot line__ 1 Number of lines,--------- ----------------------Length of each line------/ Z___� � _____.Width of trench.____ _._�_ ___.__ ____ Type of filter material_____ tlC__ .___Depth of filter material____l. ___ ______Total length---._"7`.-`�_'`P:_____-_- 1I , ;f'ta Seepage Pit: Distance to nearest well-----IL.U._______Distance from foundation____6Q_____---_.Distance to nearest lot line____________ i ❑ Number of pits- ____�_____________Lining matenal______ 6_C, ._$ize: Diameter._.S ____________..Depth____lA_______-__.____---_--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining Material-_______._..___.._..._..______--__-__. ❑ Size: Diameter---#----------------------------------Depth-=-------------------------------------------=------Liquid Capacity----------------------------gals Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildling__________________________________________ ❑ Distance to nearest lot line-------------------------------F-------------------------------------------------------------- ---------------------------------------- Remodeling and/or repairing (describe=- ---------------"4-------•----------=------------------------ --=----- ---- - --------------------------------------------------------------- --- �-- --- --k-, � � �L3� i C?.___ /lam e---/ r�.Sy/h ------------------- -- l- ---------------------------- --------------------- ------------------------------------ ------------------------------------------------------------------------------------------------ i• i ' ----------------- ------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------=--------------------------- G . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,/and mules and rl gulations.ofAthe,San.Joaquin'-L`oCal •Health,Disfrictz 'O" (Signed) a&-f- 47 V<- -----------------------------------------Owner and or Contractor # By:----------4 ------------------------ ---- -- - ------------------- ------- --------(Titl_e�.Cd-N..0 (Plot plan, showing size of lot cation of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY-------a-1_ _-0`.` DATE--__- -- •-- /sem.-' _ ____------------ -- -- -------------- -- - ---- ------ REVIEWED BY------------------------------ ......-------- --------------------------------------------------------------=----------------- DATE -- - --------------- BUILDING PERMIT ISSUED--------------- - DATE-----.---------------------- ------------------------------ Alterations and/or recommendations: -1`1�---- 7-0----- �� / 1 �- -----------•------•--------------------------------•---- -----------------------------------•--------------------------------------------------------------------------------- -_ s. ------------------------------------------------- ------------------------ ---------------------------------------- -----•-------- -- - ----------- ---------- ------------------------------------------------------------------------------------ •- ----------------------------------- --------- ------------------------------r------------------------------------- ---------I,- --------- -------------------:------- FINAL INSPECTI BY ----- --- -- Date------------- K-:---_/- -a - -- _---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.0 D.